[HSF] Post-Op Vasoplegia

[Ani Anyanwu]

Michael
 
In your thread people are confusing two distinct forms of vasoplegia.
 
There is that occuring in the intra-op or immediate peri-op phase. This is that which most responses to your thread refer to and has been attributed to various mechanisms including ACEi. This responds well to methylene blue; we have used this agent successfully on several occasions in this scenario - you will see the requirements for norepinephrine and vasopressin drop dramatically in the hours following adminstration. We have seen patients consume gallons of vasoconstrictors on CPB and struggle to maintain a mean of 50 termination of CPB despite high dose vasopressin and norepinephrine and it suddenly all reverses with methylene blue. Try it. 
 
There is the second type which seems to be the intended focus of your thread which is patients who are vasoplegic days to weeks after surgery. This form of vasoplegia I agree methylene blue will generally not help as the cause will persist. I think that this sort of vasoplegia is usually a part of multi-organ dysfunction as it is rare that the patients only problem is a requirement for vasocontrictor. Even if we could, taking the vasoplegia away is unlikely to change anything - it is probably just a manifestation of total body failure and unless an identifiable and reversible cause exists (like treatable sepsis) then the prognosis is generally poor.
 
Ani> Date: Fri, 21 Sep 2007 11:23:53 -0400> From: msfirst at gmail.com> To: OpenHeart-L at lists.hsforum.com> Subject: Re: [HSF] Post-Op Vasoplegia> CC: > > Having used M.Blue times - usually in salvage situations, I can say with 95%> confidence - doesn't work (yet, I still use it). More of what I am asking> about are these patients who are still vasodilated weeks post-op.> > > -michael> > > On 9/21/07, mdavalle at aol.com <mdavalle at aol.com> wrote:> >> > Methylene Blue pre pump for patients on ACE inhibitors.> >> >> > -----Original Message-----> > From: Michael Firstenberg <msfirst at gmail.com>> > To: OpenHeart-L at lists.hsforum.com> > Sent: Fri, 21 Sep 2007 9:59 am> > Subject: [HSF] Post-Op Vasoplegia> >> >> >> > Although it is not uncommon is some of our patients to be vasodilated> > right> > after surgery - obviously those on milrinone or pre-op ACEi, but every> > once> > in a while we have a patient who basically has no vascular tone. These> > days> > often require levo/vasopressin/etc for long periods of time and never seem> > to bounce back. Unfortunately, most of them seem to not make it and often> > this chronic pressor requirement plays a role. While sepsis may play an> > obvious role, rarely is there a source and typically these patients tend> > to> > be on/off abx anyhow.> >> > ... and we go thru the work-ups for hypothyroid, testosterone levels,> > adrenal insuff., etc - rarely does anything come up and if it does, fixing> > that problem usually does not help.> >> > Any thoughts?> >> >> > -michael> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> >> > ________________________________________________________________________> > Email and AIM finally together. You've gotta check out free AOL Mail! -> > http://mail.aol.com> > _______________________________________________> > OpenHeart-L mailing list> >> > Send postings to:> > OpenHeart-L at lists.hsforum.com> >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> > http://mmp.cjp.com/mailman/listinfo/openheart-l> >> > All messages transmitted by the OpenHeart-L are subject to the policies> > and> > disclaimers posted at:> > http://www.hsforum.com/listdisclaim> > -----------------------------------------> >> _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------
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